Grommets

Grommets are used for the treatment of middle ear infection (otitis media).  Middle ear infection is very common in early childhood and occurs when the middle ear cavity that is supposed to be filled with air gets filled with fluid (mucous or pus).  The Eustachian tube (a small tube in the middle ear) drains fluid out of the middle ear cavity but if it is not working, the fluid gets stuck and can cause an infection.   A grommet is a plastic tube used to provide a temporary, extra Eustachian tube to help bacteria and fluid to drain from the middle ear.

Grommets will usually fall out of their own accord after a number of months and the child will not even be aware that this has happened. If they do not fall out spontaneously within 18 months, they will be removed by the ENT surgeon in a simple and painless procedure.

Grommets work by ventilating the middle ear, reducing secretions and allowing better eardrum vibration “function” and giving the middle ear a chance to recover from infections.

Common Symptoms
The main reason for insert of grommets are:

• Persistent “glue ear”.  This may cause considerable hearing loss “deafness”, and sometimes earache and slight imbalance.
• Recurrent otitis media “middle ear infections”.  These are painful recurrent ear infections, which may be accompanied by a high temperature, poor appetite and general lethargy.

 

The Surgery
This is a quick (10-15 min) procedure usually performed under general anaesthesia. Grommet insertions are done on an outpatient basis. This means that your child will have surgery and then go home the same day.

A microscope is used to visualise the eardrum.   A tiny incision is made in the eardrum  and  fluid “glue” within ear is drained by suction.

A grommet is then inserted through the “hole” made in the eardrum to keep middle ear ventilated and healthy.   In a child, if adenoids are enlarged and the child is having the second or third sets of grommets inserted, the surgeon may also remove the adenoids.

After the surgery your child will go to a recovery room to be monitored closely. After your child is fully awake and doing well, the paediatric nurse will bring your child back to the day surgery area.  At this point, if everything is going well, you and your child will be able to go home.

Caring for your child after surgery
Avoid getting water into the ears as this may easily cause infection in the ears. This applies to showers, bathing, washing hair as well as swimming. Swimming is only permitted after the follow-up appointment has given the all clear. Earplugs must be used for all these activities. Alternatively, cotton wool heavily smeared with Vaseline is an excellent and sometimes more comfortable alternative.

Avoid diving with a grommet in the ear.

There may be a bloodstained discharge after the surgery for a couple of days.  If ear discharge persists, smells foul or there is increased pain contact your GP as this suggests infection and treatment with antibiotic eardrops will be required.

Pain is normally fairly minimal and can be controlled with simple painkillers.

Avoid using ear buds to clean the ear, instead use a damp cloth around the outside.

Grommets usually fall out of the ear in about 9 months. They spontaneously grow out and are ejected by the eardrum and therefore very rarely have to be removed. Usually they fall out of the ear and may be found on the pillow upon awaking. The eardrum usually heals up where the grommet was sited.

Sometimes repeat sets of grommets are needed if the fluid re-accumulates. A hearing test will indicate if this is the case.

Is there an improvement in hearing?
In 99% of cases where grommets have been inserted there is usually a dramatic improvement in hearing.

Can children swim with grommets?
There is no hard and fast rule on this. Some children with grommets are advised not to swim or to go underwater in the bath, while others are allowed to swim with ear plugs and are advised to exercise caution. Discuss this with your doctor.